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General NPI Number Information
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NPI Number | 1316246796
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Entity Type | Organization
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Legal Business Name | DOCTORS NEUROLOGICAL SERVICES OF FT LAUDERDALE INC
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 1452 N US HIGHWAY 1 SUITE 103
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City | ORMOND BEACH
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State | FL
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Zip | 32174-6638
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Country | US
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Telephone | 138-684-6269
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Fax |
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Provider Business Mailing Address
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Address Line | 1452 N US HIGHWAY 1 SUITE 103
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City | ORMOND BEACH
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State | FL
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Zip | 32174-6638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT HARGRAVE
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Credential |
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Telephone | 386-846-2698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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